The underuse of analgesia and sedation in pediatric emergency medicine

Procedural pain and anxiety in paediatric patients in a Mexican emergency department

“…In emergency rooms, children often experience unpredictable therapeutic and diagnostic procedure‐related pain that can be associated with considerable stress and anxiety (Murat et al. 2003, Razzaq 2006). These procedures may cause anxiety, fear and behavioural distress for children and their families, which further intensifies their pain and interferes with the procedures (Shavit & Hershman 2004, Cohen 2008).…”

“…2006, Eldridge & Kennedy 2010). Procedural sedation and analgesia (PSA) includes the administration of sedatives or dissociative agents with or without analgesics to induce a state that allows the children to tolerate unpleasant procedures and maintain cardio respiratory function (ACEP 1998, Krauss & Zurakowski 1998, Shavit & Hershman 2004, Razzaq 2006). Indications for PSA treatment in the paediatric emergency department can be divided into four categories: diagnostic procedures (e.g.…”

“…Procedural pain involves pain anticipation and the anxiety that is associated with the unknown. This anxiety may be magnified if a child has had a previous unpleasant experience, which increases the pain response (Goodenough et al 1999, Murat et al 2003, Razzaq 2006, Winskill & Andrews 2008, Rocha et al 2009). However, younger children typically report more pain from needles than older children (Goodenough et al 1999) and girls report more pain than boys (Unruh 1996, Goodenough et al 1999.…”

“…Emergency medicine represents another challenge because acutely ill and injured children are placed in an unfamiliar environment with unknown physicians, nurses and staff. In addition to undue pain and suffering, the stress of painful procedures influences physiological, social and cognitive outcomes, which has emotional and psychological implications for children and their families (Murat et al 2003, Razzaq 2006, Stinson et al 2008).…”

“…Distraction, hypnosis, deep breathing, blowing, suggestion, superhero imagery, rewards and cognitive behavioural therapy effectively reduce the pain and distress of these procedures (Kleiber & Harper 1999, Young 2005, Richardson et al 2006, Sinha et al 2006, Uman et al 2006, Eldridge & Kennedy 2010. Procedural sedation and analgesia (PSA) includes the administration of sedatives or dissociative agents with or without analgesics to induce a state that allows the children to tolerate unpleasant procedures and maintain cardio respiratory function (ACEP 1998, Krauss & Zurakowski 1998, Shavit & Hershman 2004, Razzaq 2006. Indications for PSA treatment in the paediatric emergency department can be divided into four categories: diagnostic procedures (e.g.…”